SENATE BILL 285 Nevada Assembly Health and Human Services Committee

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Virgil Wilcox
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1 LIFE GUARD INTERNATIONAL, INC. SENATE BILL 285 Nevada Assembly Health and Human Services Committee May 7, 2013 Testimony Donna Miller, RN/EMSRN, CMTE Dear Madam Chair Marilyn Dondero Loop and Members of the Committee, For the record, my name is Donna Miller. I am a Nevada Citizen. I am also the President of Life Guard International; a Nevada owned and operated Air Ambulance. I am also a Nevada Flight Nurse with 15 years of critical care experience and 12 years of aeromedical experience. I am supporting Senate Bill 285 which provides Patient Protection to ALL Nevada s vulnerable critically ill and injured citizens on board of an air ambulance company, by requiring ALL air ambulances providing care to Nevada citizens in Nevada to comply with the same high quality and safety standards. WHAT DOES AN AIR AMBULANCE DO? For those of you unfamiliar with air ambulance companies and personnel, they provide medical care to critically injured or ill patients onboard an aircraft, whether helicopter or airplane, while transporting patients to higher level of care facilities. For example, if the care required by an ICU patient is not available in the town or city where the patient currently is, this patient will be transported by an aircraft from the current ICU to another ICU, in another city, that can treat the patient.

record, my name is Donna Miller. I am a Nevada Citizen. I am also the President of Life Guard International; a Nevada owned and operated Air Ambulance.

2 The aircraft (and its medical personnel) serves as a bridge between the two ICUs. Therefore it is vital that the medical personnel on board of the aircraft be capable of maintaining the same level of care as that provided by the hospital s ICU. In other words, the aircraft becomes the patient s flying intensive care unit. The experience and training of the medical personnel caring for a patient aboard aircraft is critical in achieving this level of care. The reason is that unlike a hospital where support for unforeseen complications is seconds or minutes away; when you are 20,000 feet in the air and many miles from the nearest airport; there is no support for unforeseen circumstances. It is the training and experience of the medical team along with the medical equipment and supplies aboard the aircraft that makes the difference between life and death. NEVADA STATE AIR AMBULANCE REGULATION The State of Nevada understands this; reason for which Nevada choses to stringently regulate the medical aspects of air ambulance services. To protect those vulnerable sick and injured patients by ensuring they receive safe and appropriate level of medical care. Those requirements are described in NRS 450B. For example, all Nevada air ambulance companies are required to operate at a CRITICAL CARE TRANSPORT LEVEL (CCT). This ensures the patient is provided the Highest-Level-Of- Preparedness for any Unforeseen-In-flight-Changes in patient s condition. In order to function at the CCT level, the primary air medical attendant must be a licensed registered nurse. In addition, he/she must also hold an EMS-RN license (Emergency Medical Care certified Registered Nurse) issued by the Nevada State Board of Nursing. In order to get an EMSRN license a nurse must have critical care (ER or ICU) experience; maintain current certifications in BLS, ACLS, PALS, and PHTLS; complete aero medical training; and in Clark County such Nurse must pass a county protocols test. You see, obtaining the EMSRN license is both complex and rigorous; and not just any nurse can obtain it. In addition to the personnel; the medical equipment; the pharmaceuticals; the medical supplies; and the medical crews ongoing training must all meet minimum requirements and be approved. H-2

In other words, the aircraft becomes the patient s flying intensive care unit.

3 Furthermore, Nevada air ambulance companies must have a licensed physician to act as their medical director and oversee the medical operations. All this training; all this experience; all these procedures and rules have only one purpose: to make sure that every patient in Nevada receives safe and appropriate medical care. NRS 450B.830 EXEMPTIONS But there is a flaw in this comprehensive and well thought out system. NRS 450B.830 paragraph (4) and (5) currently exempts out of state air ambulance companies and their personnel from these regulations. Think about it. Nevada goes to these great lengths to protect some of their weakest and most vulnerable citizens; unless the company that transports them happens to be based elsewhere. That is because it is assumed that each State takes the responsibility of regulating the medical aspects of their air ambulance providers with the same seriousness and care that Nevada does. However, they don t. In several states, including some areas bordering Nevada, medical services for air ambulances are completely unregulated. In other words, in those areas, any person or company with an airplane licensed by the FAA to carry passengers can call itself an air ambulance provider and pick up and transport vulnerable Nevada patients with no medical oversight whatsoever. And, while Nevada patients would most likely choose a licensed air ambulance provider, it is not up to them. Because patients usually don t get to choose. In fact, many if not most patients have no say in what air ambulance service will transport them. This is because the vast majority of air ambulance transports are arranged by insurance companies. For these entities the deciding factor is price, not safe and appropriate quality of care. In addition, the choice of air ambulance providers also affects Nevada medical providers, as it increases the liability exposure of Nevada Hospitals and their medical providers. This is because according to EMTLA the sending facility and physician are legally responsible for a patient s care until the patient is seen by the receiving physician at the receiving facility. That means that H-3

830 EXEMPTIONS But there is a flaw in this comprehensive and well thought out system. NRS 450B.

4 during the transport, the sending facility is legally and medically responsible for the patient if something goes wrong. Nevada must protect its residents and visitors. By allowing unlicensed air ambulance providers to care for our already vulnerable Nevadans, we allow their lives to be further endangered. Other states have recognized this life and death risk, and as of 2006, at least 27 states had some sort of licensing requirement for out-of-state medical providers. For example, our neighbors, Utah and Arizona have similar air ambulance standards as Nevada and they do require out of state air ambulances picking up patients in their state to hold state licenses, in order to protect their citizens. PROPOSED SOLUTION Senate Bill 285 is the solution to this problem. It provides for the safety and protection of ALL Nevada citizens and visitors alike by requiring ALL air ambulances transporting patients within Nevada and from Nevada to be licensed; therefore to obey established rules and regulations meant to protect the safety and wellbeing of Nevadans. On multiple occasions I have had the opportunity to discuss this bill with each and every Nevada Air Ambulance Provider, and even with a neighboring California Air Ambulance Provider; and all agreed that this will provide for patient protection and quality of care. In closing, what I am saying is that NRS 450B.830 exemption unnecessarily endangers Nevada citizens, Nevada visitors, and it negatively impacts Nevada medical providers. The only entities benefiting are companies that are unwilling or unable to provide the quality medical care required by Nevada, therefore necessary in order to become licensed in Nevada. Second, where an air ambulance company is located and where their medical personnel live should never be a factor in whether they meet patient safety and quality of care requirements or not. Whether they are from Nevada, Utah, California or even China, if they treat Nevadans, they should obey Nevada patient safety and quality of care rules. It s only right. It s only fair. But most of all, it s only safe. Thank you for allowing me to speak. I would be happy to answer any questions you might have. Donna Miller Donna Miller, RN, EMSRN, CMTE President/ CEO Cell: efax: H-4

Other states have recognized this life and death risk, and as of 2006, at least 27 states had some sort of licensing requirement for out-of-state medical providers.

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Administrative Policy 5201

Administrative Policy 5201 Effective April 1, 2015 Expires March 31, 2016 Policy: EMS Aircraft Operations, Equipment, and... Approval: REMSA Medical Director Daved van Stralen, MD Signed Applies To: FR,